| NPI | 1790166130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.138511) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2015016477) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2020-06-02 |