| NPI | 1073872875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 51237) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX R2727) |
| 207Y00000X Otolaryngology (Licence: NY 275501) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2018-07-19 |