| NPI | 1922503556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.152713) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 65886) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2026-07-15 |