| NPI | 1891082491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CO 58725) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MI 5101019122) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2019-02-26 |