| NPI | 1225042492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: LA 017685) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 017685) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-01-18 |