| NPI | 1033554423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A160407) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD463754) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2019-07-20 |