| NPI | 1164867644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME141155) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME141155) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2019-07-02 |