| NPI | 1821231028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: DE C1-0011815) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NJ 25MA09926600) |
| 282N00000X General Acute Care Hospital (Licence: PA MD457694) | |
| 282NC2000X General Acute Care Hospital, Children (Licence: DE C1-0011815) | |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2018-06-05 |