| NPI | 1477567576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 56673) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 70947) |
| 363A00000X Physician Assistant (Licence: MN 1063258) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-19 |