| NPI | 1699708776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC SC4952) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: SC SC4952) |
| 207Y00000X Otolaryngology (Licence: SC SC4952) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2012-05-14 |