| NPI | 1992153076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 55177) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC MMD.39514 LL) |
| Enumeration Date | 2016-05-30 |
| Last Update Date | 2021-07-02 |