| NPI | 1376691683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME74727) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA C54644) |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: FL ME74727) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2024-05-24 |