| NPI | 1851397053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: NY 266912) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CT 035460) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2020-12-05 |