| NPI | 1891083689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX Q6353) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL TRN16148) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2019-02-03 |