| NPI | 1972023323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NE 7932) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2023035004) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-09-22 |