| NPI | 1689674426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NH 17443) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VT 042-0010128) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2016-07-29 |