| NPI | 1902097108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 205688) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 245287) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-03-08 |