| NPI | 1770920316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35-121662) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: ZZ R14682) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OH 35-121662) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2014-05-19 |