| NPI | 1891363214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 78228) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX BP10077014) |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2026-06-15 |