| NPI | 1710935911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME82027) |
| Additional Taxonomies | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: FL ME82027) |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: FL ME82027) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-05-06 |