| NPI | 1669812004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 308153) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MS T-2722) |
| Enumeration Date | 2013-06-30 |
| Last Update Date | 2021-04-21 |