| NPI | 1538507512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 273797) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 255848) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2018-08-16 |