| NPI | 1861697021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MD D76403) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD60276311) |
| 207Y00000X Otolaryngology (Licence: VA 0101275391) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2022-11-15 |