| NPI | 1386057255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME158179) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 256225) |
| 208D00000X General Practice (Licence: HI 18559) | |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2023-06-20 |