| NPI | 1003337809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WI 77450) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2017018862) |
| 207Y00000X Otolaryngology (Licence: MN 69733) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2022-12-07 |