| NPI | 1518237569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 328030) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD61029034) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2021-09-10 |