| NPI | 1669505046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD457425) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME103004) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2016-10-04 |