| NPI | 1568453660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MA 224441) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 224441) |
| 207YS0012X (Licence: MA 224441) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2023-11-08 |