| NPI | 1255367371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: FL ME78372) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME78372) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2010-10-07 |