| NPI | 1194816769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-3499) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: ID M-3499) |
| 207Y00000X Otolaryngology (Licence: WA MD00014948) | |
| 208600000X Surgery (Licence: WA MD00014948) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-12-14 |