| NPI | 1134112865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX J5090) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AK 4303) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2016-03-24 |