| NPI | 1316334501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 282153) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MD 1444) |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2020-04-30 |