| NPI | 1487708012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 08026) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: AL 08026) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2015-07-20 |