| NPI | 1891795779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 8408168-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WY 9203A) |
| 207Y00000X Otolaryngology (Licence: CO 42366) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2022-11-02 |