| NPI | 1245659911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD467067) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NJ 25MA10583600) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2020-01-16 |