| NPI | 1700147360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 312270) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT200885) |
| 207Y00000X Otolaryngology (Licence: MD D84488) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2021-07-07 |