| NPI | 1790984755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.092366) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO DR.0054811) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2015-06-01 |