| NPI | 1811986128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 28538) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 28538) |
| 231H00000X Audiologist (Licence: AZ 28538) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2011-03-24 |