| NPI | 1760589725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD034611E) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NJ MA53188) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-09-21 |