| NPI | 1063413961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-07-0416-N) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA ND058750L) |
| 207Y00000X Otolaryngology (Licence: CA G67510) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2014-06-26 |