| NPI | 1871678151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY KY26518) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 29708) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2013-03-28 |