| NPI | 1891226130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61543236) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301509384) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-09-17 |