| NPI | 1730169798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD458598) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: DC MD13305) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2018-12-31 |