| NPI | 1184789893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME71870) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME71870) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-07-17 |