| NPI | 1760452288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME157475) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 165672) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2023-10-23 |