| NPI | 1750642823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 3513002) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301100842) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2021-03-17 |