| NPI | 1124023874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 205062) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME98502) |
| 207Y00000X Otolaryngology (Licence: GA 050489) | |
| Enumeration Date | 2005-06-19 |
| Last Update Date | 2020-12-07 |