| NPI | 1942205604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ID M6896) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: ID M6896) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2017-04-10 |