| NPI | 1194923847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA08244600) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 233407) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2019-04-01 |