| NPI | 1003813403 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 029071)  | 
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: CT 029071)  | 
| Enumeration Date | 2005-06-30 | 
| Last Update Date | 2022-07-11 |