| NPI | 1811950744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD00018265) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD423763) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2011-11-29 |