| NPI | 1184719973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME16705) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME0016705) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME0016705) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-05-03 |