| NPI | 1225158819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IA 39460) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 54808) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2017-09-05 |