| NPI | 1841687969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101285571) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME162115) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2025-04-07 |