| NPI | 1700013711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME135329) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT195947) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2018-06-04 |