| NPI | 1548548217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MS 11522) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN MD8764) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |