| NPI | 1578565073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME 59010) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA 014768) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2011-11-29 |