| NPI | 1609086909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 268958) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT189198) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2013-09-24 |