| NPI | 1366008559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX BP10067748) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: OH 35.151256) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2024-06-19 |