| NPI | 1780356410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2021-02964) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME-0073060) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-10-04 |