| NPI | 1174578793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ME MD26424) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35072971) |
| 207Y00000X Otolaryngology (Licence: MO 2022048714) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2023-01-24 |