| NPI | 1588896401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2016-01378) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT195894) |
| 207Y00000X Otolaryngology (Licence: CA A135755) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2016-11-17 |