| NPI | 1023628666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.142601) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD470207) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2023-03-19 |