| NPI | 1184988685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301116557) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 6823) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2019-01-22 |