| NPI | 1669473237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC 15101) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 39899) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2008-05-27 |