| NPI | 1972752574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 260981) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: DC 148725) |
| 207Y00000X Otolaryngology (Licence: PA MD439641) | |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2024-03-07 |