| NPI | 1104825827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OR MD29336) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 19274) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2010-03-18 |