| NPI | 1124295423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60454300) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 60380) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2021-08-20 |