| NPI | 1316135320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME106115) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX bp20023514) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NM MD 2009-0205) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2012-01-05 |