| NPI | 1508824152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 67354) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI AB007458) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2022-04-20 |