| NPI | 1942691910 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 94705)  | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA ML60571361)  | 
| 207Y00000X Otolaryngology (Licence: MD d93191)  | |
| Enumeration Date | 2015-02-12 | 
| Last Update Date | 2023-10-26 |