| NPI | 1982818415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A81917) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A81917) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2025-08-15 |