| NPI | 1225569213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME162491) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.144870) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-07-12 |