| NPI | 1164681524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA09294700) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX P2601) |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: TX P2601) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2018-01-15 |