| NPI | 1013287101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME116212) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: OH 35.098444) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2013-09-05 |