| NPI | 1629390109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME158070) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: FL ME158070) |
| 2086X0206X Surgery, Surgical Oncology (Licence: FL ME158070) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME158070) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME158070) | |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2025-12-04 |