| NPI | 1598951444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL 39600) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME39600) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2018-03-17 |