| NPI | 1639102254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AK AA2517) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A48276) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2007-07-08 |