| NPI | 1568782019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60878924) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: HI MD-16518) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2019-02-14 |