| NPI | 1477963304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OH 35.140135) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: KY 54193) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2021-04-05 |