| NPI | 1174667521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC 29842) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2007-01044) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2021-03-31 |