| NPI | 1558392241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: PR 11698) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11698) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-05-20 |