| NPI | 1508938499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA G61452) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G61452) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2019-12-06 |