| NPI | 1902883580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC AL30700) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 153990) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2008-07-01 |