| NPI | 1720212244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: FL ME134358) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO DR.0055533) |
| 207Y00000X Otolaryngology (Licence: AZ 43315) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2018-03-17 |