| NPI | 1578563474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 021089) |
| Additional Taxonomies | 207YX0602X Otolaryngology Otolaryngic Allergy (Licence: LA 021089) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2021-08-31 |