| NPI | 1659723567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA10368900) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME149809) |
| 207Y00000X Otolaryngology (Licence: GA 8322) | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2023-01-11 |