| NPI | 1639495690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301106953) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.122233) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2015-07-29 |