| NPI | 1225176811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX L3969) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: TX L3969) |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2011-07-20 |