| NPI | 1093793010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WY 10054A) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 44355) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2020-01-22 |