| NPI | 1215991898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 39204-20) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 39204) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-11-07 |