| NPI | 1104843283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME30982) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: FL ME30982) |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: FL ME30982) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2013-12-04 |