| NPI | 1508827825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC MD 19159) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 200001456) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2021-04-26 |