| NPI | 1447646989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MS A3968) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: FL AY1666) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-08-07 |