| NPI | 1891826764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35047395) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2012-10-16 |