| NPI | 1730185216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NJ 25MAO1968500) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MAO1968500) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2018-11-13 |