| NPI | 1174727010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60459916) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301111482) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2022-02-08 |