| NPI | 1578507059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MO R7E55) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO R7E55) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-03-07 |