| NPI | 1619906807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME138168) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 26895) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2021-05-05 |