| NPI | 1154583573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 69741) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL TRN 12196) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2020-01-28 |