| NPI | 1487971008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2012005133) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 2858) |
| 207Y00000X Otolaryngology (Licence: NE 1406) | |
| 207Y00000X Otolaryngology (Licence: GA 73609) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2016-07-19 |