| NPI | 1306102280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 101240-1) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CT 014450) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2020-04-06 |