| NPI | 1659366318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD018065E) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NJ 25MA04200600) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2010-06-16 |