| NPI | 1508973843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CO 32676) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 32001) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-04-22 |