| NPI | 1053377754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME0052177) |
| Additional Taxonomies | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: FL ME0052177) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2011-10-10 |