| NPI | 1912116492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IA 38477) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA R7516) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-09-11 |