| NPI | 1376961946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME147557) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CT 63503) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-09-23 |