| NPI | 1902895782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA TMD004517) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NV 11580) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2020-06-04 |