| NPI | 1790717957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A62633) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: UT 30835651205) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-12-11 |