| NPI | 1104052042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME155474) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 46624) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2022-04-09 |