| NPI | 1407081235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NY 272264) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT195198) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2021-12-15 |