| NPI | 1972965416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NM MD2022-1264) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD61144891) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-07-12 |