| NPI | 1174643894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2007-00405) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA 2007-00405) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2021-06-18 |