| NPI | 1306229448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA 141800) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 277150) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2017-01-31 |