| NPI | 1720181845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: OH 35.149543) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD044406E) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2024-01-09 |