| NPI | 1326452855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A160436) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 30671) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2019-07-23 |