| NPI | 1417940339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME93776) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: FL ME93776) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2007-07-08 |