| NPI | 1417042730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NM MD2020-1138) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD00039985) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-01-15 |