| NPI | 1104952225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MS 18529) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: MS 18529) |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2020-01-08 |