| NPI | 1043890320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 16125A) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: WY 16125A) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2025-03-25 |