| NPI | 1114314952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 309513) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA PGY.202842) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2021-07-14 |