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 |