| NPI | 1790784627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME82539) |
| Additional Taxonomies | 207YS0012X (Licence: FL ME82539) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: FL ME82539) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME82539) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2022-09-21 |