| NPI | 1487680856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME55312) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 1410211) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2007-07-08 |