| NPI | 1417912015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 36536) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 34746-020) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2012-09-27 |