| NPI | 1831138304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME158843) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 143907) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-07-20 |