| NPI | 1396736625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 16344) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 16344) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2022-03-15 |