| NPI | 1689134710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 68164) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 30256) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2020-09-03 |