| NPI | 1982760849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME100849) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD426506) |
| 207Y00000X Otolaryngology (Licence: MI 4301089217) | |
| 207Y00000X Otolaryngology (Licence: PA MT180627) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2008-10-29 |