| NPI | 1760460414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA C55835) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 27265) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2015-06-25 |