| NPI | 1093752719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME 98348) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 66483) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2011-08-25 |