| NPI | 1154581395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.202934) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA pgy.1.lsun-otol) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2019-02-20 |