| NPI | 1679682892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 211519) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 211519) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-07-08 |