| NPI | 1386640662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.120185) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WV 13857) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2014-08-07 |