| NPI | 1740252105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME153243) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 282387) |
| 207Y00000X Otolaryngology (Licence: VA 0101232142) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2022-12-21 |