| NPI | 1679992887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NH 19799) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.024576) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2019-09-20 |