| NPI | 1376520049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SD 11214) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 20580) |
| 207Y00000X Otolaryngology (Licence: MO 2020030112) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2022-11-02 |