| NPI | 1417303694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.145553) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 63187) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2022-07-19 |