| NPI | 1174527543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NJ 25MA05350800) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA053508) |
| 207Y00000X Otolaryngology (Licence: NJ 25MA05350800) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2019-04-12 |