| NPI | 1720345044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 67502) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 75085) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2021-07-22 |