| NPI | 1619987997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA MD.203050) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA lt000592) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-05-19 |