| NPI | 1205462199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME180523) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 336403) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2026-07-04 |