| NPI | 1033189758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 41782) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME74096) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-04-07 |