| NPI | 1043259666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME164698) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 231752) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2024-12-03 |