| NPI | 1851753446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA OS021076) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA 302434) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2022-10-13 |