| NPI | 1063510493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E5747) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX E5747) |
| 174400000X Specialist | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-11-12 |