| NPI | 1548325855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A108204) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35086081) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2011-03-08 |