| NPI | 1104137710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 64925) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 286751) |
| 207Y00000X Otolaryngology (Licence: WI 57661-20) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2024-02-16 |