| NPI | 1194169714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OH 35.136448) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD464209) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2019-06-12 |