| NPI | 1558307967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD026254E) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 15410501) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2021-03-25 |