| NPI | 1023679271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: SC AL87649) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.246883) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2022-09-27 |