| NPI | 1891781480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MS 20619) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: KY 39361) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2013-11-13 |