| NPI | 1528163979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NY 252522) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WV 21280) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-02-10 |