| NPI | 1336186790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61316786) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301053355) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-08-08 |