| NPI | 1902905219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME125739) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX H5856) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-04-06 |