| NPI | 1568593739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 013371) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA MD.013371) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-06-16 |