| NPI | 1205148541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 10456892-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 38365) |
| 207Y00000X Otolaryngology (Licence: NE 27421) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2021-06-07 |