| NPI | 1164420071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME0061454) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: FL ME0061454) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2013-02-27 |