| NPI | 1053542936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME129011) |
| Additional Taxonomies | 207YS0012X (Licence: FL ME129011) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2023-11-17 |