| NPI | 1609372853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME170971) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301509228) |
| 207Y00000X Otolaryngology (Licence: MN 78120) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2025-04-28 |