| NPI | 1215066873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WV WV10321) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WV WV10321) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-05-26 |