| NPI | 1669650925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A94818) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV 14448) |
| 207Y00000X Otolaryngology (Licence: MI 4301097726) | |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2020-05-28 |