| NPI | 1003897778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME77298) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME0077298) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AL 22542) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2012-04-19 |