| NPI | 1720177157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A45504) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK A45504) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-02-17 |