| NPI | 1003103615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: NY 282881) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT199956) |
| Enumeration Date | 2011-07-03 |
| Last Update Date | 2018-01-15 |