| NPI | 1558344515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME0015334) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AL 11287) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-07-08 |