| NPI | 1528004520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MT MT7342) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WY WY5324A) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-08 |