| NPI | 1033145578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OR MD23944) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: CA G22730) |
| 261QP2400X Clinic/Center, Prison Health (Licence: OR MD23944) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2008-08-15 |