| NPI | 1124258884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MT205780) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL TRN13671) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2015-05-11 |