| NPI | 1306004460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: LA DO.000218) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OH 34.009560) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2017-04-05 |