| NPI | 1104077650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 048958) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX N3160) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2012-02-07 |