| NPI | 1962494815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME0060810) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0060810) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2019-05-03 |