| NPI | 1497970057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 49428) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A120732) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-06-18 |