| NPI | 1356344717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-058294) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OR 150885) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2020-09-10 |