| NPI | 1588640015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME85915) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KY TP896) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2021-10-04 |