| NPI | 1639162852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NH 13560) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME93825) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2019-03-22 |