| NPI | 1205837689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME165334) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301501449) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2024-09-04 |