| NPI | 1184981383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A155146) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2017-00389) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2019-08-12 |