| NPI | 1730112640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME107918) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 148573) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2012-07-23 |