| NPI | 1174511158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: ME 1526) |
| Additional Taxonomies | 207YS0012X (Licence: ME 1526) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2012-04-13 |