| NPI | 1003812009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 022795) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: LA 022795) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2007-07-08 |