| NPI | 1295767184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 213533) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 227868) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-23 |