| NPI | 1700109030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA 20A13047) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA OT013208) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2018-01-11 |