| NPI | 1861752420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD455969) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT201622) |
| 207Y00000X Otolaryngology (Licence: MN 61521) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2020-05-21 |