| NPI | 1720210800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 246894) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 00000000) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2012-02-16 |