| NPI | 1467619973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME110306) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 245254) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2013-01-28 |