| NPI | 1972690097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2007-01887) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN MD36239) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2008-03-27 |