| NPI | 1679523500 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OK 23295) | 
| Additional Taxonomies | 174400000X Specialist (Licence: OK 23295) | 
| Enumeration Date | 2006-05-11 | 
| Last Update Date | 2016-06-01 |