| NPI | 1639523434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME157087) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX S8914) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2022-08-17 |