| NPI | 1902075054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-091099) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35-091099) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2010-02-16 |