| NPI | 1720407133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: OH 35.141210) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.024714) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-05-05 |