| NPI | 1538142187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA03285800) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NJ MA32858) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2023-07-20 |