| NPI | 1164425500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: VA 0101059235) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: VA 0101059235) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2011-03-29 |