| NPI | 1497751663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX J3574) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J3574) |
| 174400000X Specialist (Licence: NM 86103) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX J3574) | |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: TX J3574) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2011-01-31 |