| NPI | 1124059555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: RI RI6624) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: RI RI6624) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2008-02-20 |