| NPI | 1962455519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 11027) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: SC 11207) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: SC 11207) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-09-02 |