| NPI | 1679663207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA 60914678) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA G89294) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-04-30 |