| NPI | 1063788461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.133158) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX R0595) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2018-07-20 |