| NPI | 1710963905 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD437429) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MD D0062391) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2023-01-27 |