| NPI | 1679968820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD472950) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.026618) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: PA MT221150) | |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2023-02-10 |