| NPI | 1134112261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME134346) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 24197) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME134346) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2023-04-21 |