| NPI | 1265532444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VT 420006154) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NH 5870) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |