| NPI | 1619015328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 11846) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN MD0000012974) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |