| NPI | 1316018153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 135017) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 75816) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2024-07-23 |