| NPI | 1831394709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME 112589) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 233137) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2022-12-19 |