| NPI | 1710272034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: OH 35.133129) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301098986) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2018-03-28 |