| NPI | 1255575817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX Q3831) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 62468-20) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2015-07-23 |