| NPI | 1104811868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD014678E) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NJ 25MA03177800) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2007-07-08 |