| NPI | 1407054760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2012-00123) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH MELO02) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2024-06-14 |