| NPI | 1104862465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 28993) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 28993) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2009-11-20 |