| NPI | 1689858201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 46178) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 129298) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2023-02-15 |