| NPI | 1831406040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 54936) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA OT012128) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2014-02-24 |