| NPI | 1023218617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60564654) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: WA MD60564654) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2015-08-17 |