| NPI | 1285800573 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: SC 30816) | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101256335) | 
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MN 56411) | |
| Enumeration Date | 2008-05-06 | 
| Last Update Date | 2024-07-23 |