| NPI | 1124414016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX 47650) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD473664) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-07-08 |