| NPI | 1508974395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME131217) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA G67891) |
| 207Y00000X Otolaryngology (Licence: GA 040328) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-06-01 |