| NPI | 1821447426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX T0445) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX T0445) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2022-09-12 |