| NPI | 1235484429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.137457) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME132660) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2019-09-11 |