| NPI | 1679834089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MO 2024039721) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 73082-20) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: KS 04-49773) | |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: MO 2024039721) | |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: KS 04-49773) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2024-10-02 |