| NPI | 1215039235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OR MD16012) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD00034650) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2010-01-27 |