| NPI | 1912930777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 39450) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2013000673) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-01-13 |