| NPI | 1720178775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME122440) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 18366) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-11-01 |