| NPI | 1285792143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 279632-1) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101240508) |
| 207Y00000X Otolaryngology (Licence: ND 12940) | |
| 207Y00000X Otolaryngology (Licence: MI 4301104789) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2018-03-17 |