| NPI | 1457340853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: MA 203456) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 203456) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2014-07-23 |