| NPI | 1407922669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC TL35136) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA C042081) |
| 207Y00000X Otolaryngology (Licence: GA 62399) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-07-09 |