| NPI | 1811202633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02438500) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD458380) |
| 207Y00000X Otolaryngology (Licence: PA MD458380) | |
| 207YS0012X Otolaryngology Sleep Medicine (Licence: PA MD458380) | |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2022-08-04 |