| NPI | 1760778682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC 39154) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2011015260) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2016-06-21 |