| NPI | 1134486681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A156572) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: CA A156572) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CA A156572) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2020-07-29 |