| NPI | 1487604005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A49647) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2006-00446) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2018-06-20 |