| NPI | 1124477211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA D7935901) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A150427) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-08-23 |