| NPI | 1154365450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA08694400) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 203002-1) |
| 207YS0012X (Licence: NY 203002) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2018-09-30 |