| NPI | 1922184647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WY 5710A) |
| Additional Taxonomies | 332S00000X Hearing Aid Equipment |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WY 5710A) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2010-10-13 |