| NPI | 1285719708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ID M5057) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID M5057) |
| 174400000X Specialist (Licence: MN 29197) | |
| 174400000X Specialist (Licence: PA MD025690-E) | |
| 174400000X Specialist (Licence: MT 5147) | |
| 174400000X Specialist (Licence: WA MD00022835) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-10-09 |