| NPI | 1225142896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 258278) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NM 2006-0201) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NY 258278) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2010-12-21 |