| NPI | 1114943222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME121668) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 28294) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-03-28 |