| NPI | 1649475583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME117335) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NJ 25MA09108500) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2016-05-08 |