| NPI | 1053368308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 7456) |
| Additional Taxonomies | 207YX0602X Otolaryngology Otolaryngic Allergy (Licence: AZ 7456) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 7456) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: AZ 7456) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2008-07-30 |