| NPI | 1457413643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: WA MD00011640) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD00011640) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2009-02-03 |