| NPI | 1568996775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME161800) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2022-01059) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME161800) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2023-07-17 |