| NPI | 1952306458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 32948) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 32948) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2012-08-14 |