| NPI | 1164865184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 86538) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD60977478) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2020-10-29 |