| NPI | 1255406898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME128553) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: ND 13287) |
| 208D00000X General Practice (Licence: IN 01061468A) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2017-10-13 |