| NPI | 1770717456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301107694) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD450585) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2022-04-12 |