| NPI | 1619944477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WV 15360) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35078614S) |
| 207Y00000X Otolaryngology (Licence: KY 30789) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2008-06-06 |