| NPI | 1316911720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 147068) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 79714) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2019-04-03 |