| NPI | 1508817636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD054167L) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NJ 25MA05769700) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2009-11-05 |