| NPI | 1619162856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 012531) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 012531) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2007-10-30 |