| NPI | 1417084351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 1131) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 43586) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: KY 43586) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2014-06-02 |