| NPI | 1700154275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ID M-16159) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 25883) |
| 208D00000X General Practice (Licence: NE 25883) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2024-04-24 |