| NPI | 1124480702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.141295) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KY R4146) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2022-07-21 |