| NPI | 1124184072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME106030) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT186823) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2013-02-12 |