| 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 |