| NPI | 1003910472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: NJ 25MA07392400) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: NJ 25MA06592400) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2019-01-24 |