| NPI | 1841309580 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 246671) | 
| Additional Taxonomies | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: CA A107293) | 
| Enumeration Date | 2006-08-29 | 
| Last Update Date | 2021-02-09 |