| NPI | 1962491167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME85949) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: GA 84424) |
| 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: FL ME85949) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2020-11-04 |