| NPI | 1770572810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 11281) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AL 00011281) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2019-10-08 |