| NPI | 1205838612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX N2246) |
| Additional Taxonomies | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: NC 2001-01593) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2023-02-17 |