| NPI | 1609005511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301093464) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: MI 4301093464) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-08-17 |