| NPI | 1760644280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA09356100) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD60287386) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2013-11-04 |