| NPI | 1255444212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 54812) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 21752) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2021-06-18 |