| NPI | 1972763399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: NY 281238) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT193222) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2015-09-14 |