| NPI | 1194751859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME137191) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 34009) |
| 207Y00000X Otolaryngology (Licence: WI 24691-20) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-06-02 |