| NPI | 1629565064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 310335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 310335) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2022-07-25 |