| NPI | 1033139480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: FL ME111289) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35-069095) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-03-15 |