| NPI | 1134673502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25ma09857200) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NJ 25ma09857200) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |