| NPI | 1912978073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 227904) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: RI MD16864) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-10-24 |