| NPI | 1932309135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA 60249285) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.013007) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2012-06-18 |