| NPI | 1548695729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 11131583-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX R6005) |
| 207Y00000X Otolaryngology (Licence: MO 2013019934) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2019-08-16 |