| NPI | 1750795670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 68193) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA R-10112) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2021-06-16 |