| NPI | 1104110709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME 125446) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA R-9195) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2020-02-08 |