| NPI | 1902394406 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 78338) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 84952) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2025-02-20 |