| NPI | 1306962592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 64013) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 243336) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2010-07-07 |