| NPI | 1619067436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ID M-10288) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 22476) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2010-06-01 |