| NPI | 1932301892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PR 16503) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME104110) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2011-03-09 |