| NPI | 1104818350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME96773) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX L9631) |
| 207YS0012X Otolaryngology, Sleep Medicine (Licence: FL ME96773) | |
| 207YS0012X Otolaryngology, Sleep Medicine (Licence: TX L9631) | |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: FL ME96773) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2019-04-13 |