| NPI | 1356517767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME107157) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME107157) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019049) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2021-03-23 |