| NPI | 1104072354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 054882) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 236469) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2022-07-11 |