| NPI | 1659566560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60340252) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 52979) |
| 207Y00000X Otolaryngology (Licence: CA A87603) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2014-10-07 |