| NPI | 1912117805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OR MD28034) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD60390275) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-12-05 |