| NPI | 1871811612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TN 65754) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.126440) |
| 207Y00000X Otolaryngology (Licence: FL ME128330) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME128330) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2022-10-03 |