| NPI | 1356662936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2017-00492) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC LL32712) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2021-04-29 |