| NPI | 1780654822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD418361) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 46193) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2011-05-18 |