| NPI | 1376632778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MD D0030027) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: DC MD17378) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-09 |