| NPI | 1912149055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 5315150690) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301030390) |
| 207Y00000X Otolaryngology (Licence: GA 63400) | |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2020-12-29 |