| NPI | 1912988692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME 120665) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CT 033354) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2021-05-24 |