| NPI | 1780802447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME101557) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 69013) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2015-06-22 |