| NPI | 1063496941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101245034) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.048273) |
| Enumeration Date | 2005-12-03 |
| Last Update Date | 2012-07-27 |