| NPI | 1295077014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2019-00904) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.133896) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2021-04-27 |