| NPI | 1568486819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 151412) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.151462) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-07-16 |