| NPI | 1790028199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL MD.37063) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.022811) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2018-07-03 |