| NPI | 1205990868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A101924) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 47283-020) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2009-11-20 |