| NPI | 1588919633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX U0444) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 67261-20) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2023-03-01 |