| NPI | 1518298587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX Q0962) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX BP10030817) |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2020-11-20 |