| NPI | 1093134173 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A142734)  | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA MD-46065)  | 
| Enumeration Date | 2014-04-16 | 
| Last Update Date | 2020-07-13 |