| NPI | 1396159661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME141300) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 30723) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2022-08-12 |