| NPI | 1497709018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-03-4973) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WV 13013) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2011-10-24 |