| NPI | 1083682637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD050918L) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WV 30156) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2021-01-19 |