| NPI | 1609837863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: NY 186332) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 186332) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2012-01-03 |