| NPI | 1760576581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD455213) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 23909) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-08-05 |