| NPI | 1639518673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2018007938) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 7006) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-04-23 |