| NPI | 1427340454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME132089) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 128442) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2022-07-21 |