| NPI | 1700821907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-07-8877-R) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WV 17624) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2015-02-09 |