| NPI | 1255793147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX T7186) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME149513) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2025-06-13 |