| NPI | 1811242704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: OH 35.136122) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IL 125061432) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2019-05-21 |