| NPI | 1881955011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 8797739-8905) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL 34682) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2017-01-31 |