| NPI | 1649296914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WY 9739A) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 073897) |
| 207Y00000X Otolaryngology (Licence: WI 1272) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-10-08 |