| NPI | 1376997957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX S9534) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MS T-3139) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2021-08-30 |