| NPI | 1407065980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A147549) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA R7886) |
| 207Y00000X Otolaryngology (Licence: GA 069817) | |
| 207Y00000X Otolaryngology (Licence: VA 0101256465) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2017-06-19 |