| NPI | 1053487421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 055213) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301052477) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-06-20 |