| NPI | 1376049262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ID 7861574) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A164031) |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: AZ 71753) | |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2024-11-12 |