| NPI | 1003043902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME148780) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35126041) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2023-08-25 |