| NPI | 1902990385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NM 2003004) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35-068772) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-05-02 |