| NPI | 1861452070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 48546361205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: UT 4854636-1205) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2017-05-02 |