| NPI | 1376839944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA 60892789) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2011015922) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2019-03-14 |