| NPI | 1669620589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME 114747) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA L19947193) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2022-12-19 |