| NPI | 1740268259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 14766) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: AL 14766) |
| 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: AL 14766) | |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: AL 14766) | |
| 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: AL 14766) | |
| 207YX0602X Otolaryngology Otolaryngic Allergy (Licence: AL 14766) | |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: AL 14766) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2010-09-27 |