| NPI | 1659456259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME82686) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME82686) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2015-02-02 |