| NPI | 1831207760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101027211) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 16027) |
| 207Y00000X Otolaryngology (Licence: FL ME17505) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2013-01-08 |