| NPI | 1457318529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CO DR.0046000) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101038731) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-09-10 |