| NPI | 1720281710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60749737) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: HI 17070) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2022-07-21 |