| NPI | 1255774998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 87175) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX R6106) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2021-03-02 |