| NPI | 1912584996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 36008) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2026-05-06 |