| NPI | 1710913223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A67985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A67985) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2007-07-08 |