| NPI | 1124313614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35136977) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AK 109905) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2019-09-12 |