| NPI | 1164423299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: NJ 25MA05512700) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: NY 177474-1) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2012-06-04 |