| NPI | 1407857162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-04-4832) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35044832) |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: OH 35044832) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-09-24 |