| NPI | 1336129543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 6945748-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 46942) |
| 207Y00000X Otolaryngology (Licence: AL MD28999) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2012-07-23 |