| NPI | 1669729968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA 61074832) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2012019655) |
| 207Y00000X Otolaryngology (Licence: CA A162447) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2020-10-13 |