| NPI | 1477550861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX D4715) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX D4715) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-01-28 |