| NPI | 1790313187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NJ 25MA12554000) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 344519) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2026-05-22 |