| NPI | 1508905548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 271897) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NM 2006-0352) |
| 207Y00000X Otolaryngology (Licence: PA MD442128) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2013-09-24 |