| NPI | 1316163066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2018-01301) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.010493) |
| 207Y00000X Otolaryngology (Licence: IL 36.125963) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2018-08-29 |