| NPI | 1184712895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD449634) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 14517) |
| 207Y00000X Otolaryngology (Licence: NJ 25MA10946200) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-02-22 |