| NPI | 1639137110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301069826) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MD D62105) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MI 4301069826) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2012-04-02 |