| NPI | 1023320108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OK 31696) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301096728) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2019-03-15 |