| NPI | 1619940210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ND 12956) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO 40207) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2013-12-31 |