| NPI | 1609878313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME0056965) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME0056965) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2011-08-13 |