| NPI | 1609878255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD477388) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AL 20825) |
| 207Y00000X Otolaryngology (Licence: VA 0101258484) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2022-12-20 |