| NPI | 1629459243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.151538) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 1014745) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2024-07-26 |