| NPI | 1528238805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OR 29320) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.006965) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2020-11-17 |