| NPI | 1972512325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX temporary) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: ND 11471) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-09-24 |