| NPI | 1609874999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: CT 047116) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 28059) |
| 207Y00000X Otolaryngology (Licence: NY 127880) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2015-05-12 |