| NPI | 1356429658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301079386) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35088248) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2019-08-28 |