| NPI | 1962938209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PR 22947) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 314380) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2024-04-18 |