| NPI | 1811314784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61040448) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 70680) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2021-09-27 |