| NPI | 1013223239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301096231) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MI 4301096231) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2015-05-30 |