| NPI | 1104244854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60774816) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2020-00390) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-08-26 |