| NPI | 1568704963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA 61154619) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AK 134259) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2021-12-13 |