| NPI | 1609163005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 300797) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MS T-2440) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2019-10-30 |