| NPI | 1649375759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA08211600) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35087532) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2012-05-20 |