| NPI | 1336261056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA09215000) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 243222) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NJ 25MA09215000) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-04-01 |