| NPI | 1235150491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME150710) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA G153276) |
| 207Y00000X Otolaryngology (Licence: MN 33333) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2023-04-11 |