| NPI | 1326465352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME144638) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0116027480) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2022-08-02 |