| NPI | 1174963532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.133255) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.024571) |
| 208600000X Surgery (Licence: SC LL35769) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2022-08-11 |