| NPI | 1134688286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AR E-17983) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME183178) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2026-08-25 |