| NPI | 1417451089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PR 023579) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME162825) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-04-18 |