| NPI | 1720065295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ME MD22447) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IN 01056203A) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX P0440) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2019-05-24 |