| NPI | 1215484647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 310582) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101262818) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2018-08-28 |