| NPI | 1386829604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A102384) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 260338) |
| Enumeration Date | 2008-01-05 |
| Last Update Date | 2014-09-09 |