| NPI | 1174773485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0116028175) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: AL 1001941) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2018-06-15 |