| NPI | 1730161621 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD037531E) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 168453) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2020-08-05 |