| NPI | 1639127798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME126213) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 224799) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-10-11 |