| NPI | 1144348558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.099864) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OH 35.099864) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2016-03-18 |