| NPI | 1114346251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ME DO2892) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA OT015658) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-05-07 |