| NPI | 1750318424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX U6802) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.085331) |
| 207Y00000X Otolaryngology (Licence: TX U6802) | |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: AZ 36508) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2025-09-23 |