| NPI | 1720469380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 64501) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2020-01665) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-01-12 |