| NPI | 1043584485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WI 68614) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL OS14048) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2023-08-23 |