| NPI | 1760509624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX P0999) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO 47415) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2022-01-25 |