| NPI | 1972593242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: MA 209430) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 209430) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2023-11-08 |