| NPI | 1891704839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME138055) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO 28484) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-09-09 |