| NPI | 1770541104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN MD6781) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD0000006781) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2009-12-23 |