| NPI | 1780712752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0602X Otolaryngology Otolaryngic Allergy (Licence: WV WV14772) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: ND PT21491) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2024-09-23 |