| NPI | 1679839922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD465205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME130957) |
| 207Y00000X Otolaryngology (Licence: NJ 25MA10412000) | |
| 207Y00000X Otolaryngology (Licence: WV 26057) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2020-06-05 |