| NPI | 1912990433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX M6915) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO 40538) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2008-05-01 |