| NPI | 1487608246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CO 50994) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101050521) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2017-05-04 |