| NPI | 1275557738 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 213462) | 
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MA 213462) | 
| Enumeration Date | 2006-07-27 | 
| Last Update Date | 2018-05-08 |