| NPI | 1902048952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.124086) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0116021508) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2022-02-17 |