| NPI | 1043306392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 205801) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A94147) |
| 207Y00000X Otolaryngology (Licence: TX M6514) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-10-24 |