| NPI | 1871988915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2025029226) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2021-01892) |
| 207Y00000X Otolaryngology (Licence: MS 30284) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-07-21 |