| NPI | 1396270856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NJ 25MA12451300) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME156559) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2026-05-08 |