| NPI | 1225303001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101251391) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX R7465) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2022-12-06 |