| NPI | 1871501643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: NJ 25MA09990100) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 48775) |
| 207Y00000X Otolaryngology (Licence: NJ 25MA09990100) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2019-06-19 |