| NPI | 1104031053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN MD0000042138) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 236177) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TN MD42138) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2022-03-21 |