| NPI | 1881690600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME0074316) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME74316) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2019-05-03 |