| NPI | 1205850153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 200300949) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2003-00949) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-06-29 |