| NPI | 1568585891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA c142543) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 231777) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-07-19 |