| NPI | 1649596800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301113636) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD454807) |
| 207Y00000X Otolaryngology (Licence: LA 303189) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2018-03-17 |