| NPI | 1790881613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KS 0433487) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2001027197) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2012-07-27 |