| NPI | 1609841048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA G152101) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD056293L) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2018-03-17 |