| NPI | 1457745929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 53608) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: KY 53608) |
| 207Y00000X Otolaryngology (Licence: OH 57.026247) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2021-01-19 |