| NPI | 1629268818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA MD.207210) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 254911) |
| 207Y00000X Otolaryngology (Licence: NM MD2012-0579) | |
| 207Y00000X Otolaryngology (Licence: WA MD60271014) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2014-12-16 |