| NPI | 1306839568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA G39474) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35053497) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2011-12-21 |