| NPI | 1659382117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WI 39103) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: WI 39103) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2015-04-09 |