| NPI | 1922216001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CT CT049445) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT186325) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2022-04-13 |