| NPI | 1871540567 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ND 12266) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KY 41717) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: KY 41717) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2025-01-16 |