| NPI | 1770564346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD073620-L) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: PA MD073620-L) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: PA MD073620-L) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2013-07-23 |