| NPI | 1255334298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN MD 30662) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101058761) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2009-09-18 |