| NPI | 1659750370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101275751) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 87893) |
| 207Y00000X Otolaryngology (Licence: FL ME143059) | |
| 207Y00000X Otolaryngology (Licence: SC 38244) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: GA 87893) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2026-01-26 |