| NPI | 1972712842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 256745-1) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 19693) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2023-03-09 |