| NPI | 1154506913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 44899) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 090850) |
| Enumeration Date | 2007-12-29 |
| Last Update Date | 2020-09-10 |