| NPI | 1609860477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 65101) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX M7263) |
| 207Y00000X Otolaryngology (Licence: AZ 25217) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2020-11-24 |