| NPI | 1790097087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX P2212) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MO 2010015930) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: KS 04-35115) | |
| 207Y00000X Otolaryngology (Licence: TX P2212) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2013-08-02 |