| NPI | 1023052107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-03-5150) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WV 13304) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-09 |