| NPI | 1962039818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME181468) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PA MD489681) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2026-07-21 |