| NPI | 1518967793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 10820R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 10820R) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2024-06-08 |