| NPI | 1568477982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NH 15543) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NH T0557) |
| 207Y00000X Otolaryngology (Licence: MN 104228) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-08-31 |