| NPI | 1124073309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: CA G56927) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 26538) |
| 2086S0120X Surgery Pediatric Surgery (Licence: OH 35083148) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2019-10-17 |