| NPI | 1629398706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: WV MD60770094) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD60770094) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2023-08-23 |