| NPI | 1255596771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ID M11986) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT191505) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2014-01-31 |