| NPI | 1508026907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 273904) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME115108) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2015-02-06 |