| NPI | 1447205067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 22284) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NJ 22284) |
| 207Y00000X Otolaryngology (Licence: NY 236854) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2011-11-18 |