| NPI | 1295074458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 53661) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A124493) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2020-02-18 |