| NPI | 1780685651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SD 5933) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MT 10034) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2008-05-09 |