| NPI | 1760465850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.040831) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35040831) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: OH 35.040831) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2015-06-30 |