| NPI | 1114065406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: NJ 25MA10294300) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411071) |
| 207Y00000X Otolaryngology (Licence: TX Q0461) | |
| 207Y00000X Otolaryngology (Licence: AL 36041) | |
| 207Y00000X Otolaryngology (Licence: NJ 25MA10294300) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-12-12 |