| NPI | 1265967905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.148701) |
| Additional Taxonomies | 207YS0012X (Licence: OH 35.148701) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2023-07-06 |