| NPI | 1457882268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PR 23072) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 314280) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-06-07 |