| NPI | 1366739153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 277368) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD457050) |
| 207Y00000X Otolaryngology (Licence: CA A 125762) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2021-05-03 |