| NPI | 1316203722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 319781) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2023-12-25 |