| NPI | 1962608059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX R8787) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD 431620) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2022-11-30 |