| NPI | 1215019179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY TP580) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME133285) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-03-18 |