| NPI | 1366415275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 205842) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NH 18281) |
| 207Y00000X Otolaryngology (Licence: VT 042.0013772) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2019-04-04 |