| NPI | 1528290541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-121559) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT191419) |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2021-01-06 |