| NPI | 1194957589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 263693) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT195896) |
| 207Y00000X Otolaryngology (Licence: NY 273375) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2015-12-09 |