| NPI | 1912903469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 32074) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA 088562) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2012-10-09 |