| NPI | 1124092630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: SC 16045) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 16045) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-08-18 |