| NPI | 1134330434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CO 46295) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57006963) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CO 46295) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2012-06-13 |