| NPI | 1457472961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60773432) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH MD27299) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2023-10-17 |