| NPI | 1003010703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX M8557) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX M8557) |
| 207YS0012X (Licence: TX M8557) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-11-20 |