NPI | 1609372853 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME170971) |
Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301509228) |
207Y00000X Otolaryngology (Licence: MN 78120) | |
Enumeration Date | 2018-04-04 |
Last Update Date | 2025-04-28 |