| NPI | 1568500189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: CO 39522) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2021-05-15 |