| NPI | 1790152155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A172127) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 62576) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2021-11-02 |