| NPI | 1083239529 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NH 34482) | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: ME DO4072) | 
| Enumeration Date | 2020-06-10 | 
| Last Update Date | 2025-06-19 |