| NPI | 1013997485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2015-00874) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 2015-00874) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2017-03-17 |