NPI | 1568463347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME130068) |
Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 256147) |
207Y00000X Otolaryngology (Licence: NY 001944) | |
Enumeration Date | 2005-08-03 |
Last Update Date | 2020-12-10 |