| NPI | 1992717961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101051856) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 200301382) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-09-07 |