| NPI | 1104245018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0901X Otolaryngology Otology & Neurotology (Licence: WI 64553-20) |
| Additional Taxonomies | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: WI 64553) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2022-10-11 |