| NPI | 1790757722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD042488L) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: ND 11880) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-03-08 |