| NPI | 1902250921 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0012X (Licence: MI 4301503926) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301503926) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2024-03-20 |