| NPI | 1700340932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 278166) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 316535) |
| 208D00000X General Practice (Licence: GA 93301) | |
| 208D00000X General Practice (Licence: WV 31732) | |
| 208D00000X General Practice (Licence: OH 35.141451) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2022-10-07 |