| NPI | 1518108711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: OK 5501) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MI 5101017956) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MO 2013021744) | |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2018-04-12 |