| NPI | 1568498475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 080260) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA SLG76942) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-07-23 |