| NPI | 1912958067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CO 50262) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 48793) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2021-06-18 |