| NPI | 1790781250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 007227) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA OS008222L) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2018-06-16 |