| NPI | 1417990128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME104254) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MD D60607) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-04-10 |