| NPI | 1528679768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC 87655) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA 216596) |
| 207Y00000X Otolaryngology (Licence: CA F650) | |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2022-10-04 |