| NPI | 1295911790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101022406) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101022406) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-14 |