| NPI | 1780099150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA OP60917802) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2014018831) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2019-10-11 |