| NPI | 1225109507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME102510) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: LA 026204) |
| 171000000X Military Health Care Provider (Licence: FL ME102510) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2020-05-12 |