| NPI | 1942243357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA08812200) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 232382) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-04-01 |