| NPI | 1215355748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A167806) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.135613) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-08-21 |