| NPI | 1366590820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60086328) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 239514) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-11-01 |