| NPI | 1932655214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 270978) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MD P32670) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2018-03-17 |