| NPI | 1982689014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA06680900) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 193446-1) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2025-06-27 |