| NPI | 1396765871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 6959601-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OR MD25626) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-02-01 |