| NPI | 1194718213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: IA 27940) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA 27940) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2007-12-18 |