| NPI | 1194988782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NY 266719) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 266719) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NY 266719) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OH 128857) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2016-07-09 |