| NPI | 1972610103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX E9208) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX E9208) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2018-12-03 |