| NPI | 1649407487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 206975) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA R-8725) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2020-12-11 |