| NPI | 1588625974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WV 20217) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35080785) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2015-05-13 |