| NPI | 1073806378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME151381) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX S4846) |
| 207Y00000X Otolaryngology (Licence: KY R2620) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2021-08-04 |