| NPI | 1043207483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2012001985) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 17617) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2013-05-30 |