| NPI | 1649698770 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 52371) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57-024381) |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: KY 52371) | |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2021-01-19 |