| NPI | 1033111000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 79451) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35078360) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2019-05-02 |