| NPI | 1003079062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A107865) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A107865) |
| 207Y00000X Otolaryngology (Licence: NY 264655) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2013-08-22 |