| NPI | 1124191267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2007-01072) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MT 10663) |
| 207Y00000X Otolaryngology (Licence: ND 9862) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2011-07-18 |