| NPI | 1508246703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A169469) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD-18979) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2021-06-10 |