| NPI | 1225322423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA OS017821) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA OT014251) |
| 207Y00000X Otolaryngology (Licence: CA 20A14339) | |
| Enumeration Date | 2011-06-05 |
| Last Update Date | 2018-01-07 |