| NPI | 1336570019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KS 04-13093) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2010042691) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2013-12-06 |