| NPI | 1548420847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 258713) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI rph04504) |
| 183500000X Pharmacist (Licence: MA 26336) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2015-05-26 |