| NPI | 1154570679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 253792) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A105098) |
| 207Y00000X Otolaryngology (Licence: PA MT183380) | |
| 207Y00000X Otolaryngology (Licence: NY 301004) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2021-04-02 |