| NPI | 1760917157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2023-01211) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A157348) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-12-03 |