| NPI | 1376532275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 80887) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 80887) |
| 231H00000X Audiologist | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2009-01-26 |