| NPI | 1790912780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A142924) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: HI 16072) |
| 208D00000X General Practice (Licence: HI 16072) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2016-08-04 |