| NPI | 1982609061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD443576) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101040423) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2011-09-20 |