| NPI | 1124327507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 50689) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 28135) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2018-01-11 |