| NPI | 1598804825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2009001424) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 23984) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2019-10-31 |