| NPI | 1043223514 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: WA MD00048531) | 
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA MD00048531) | 
| Enumeration Date | 2006-08-14 | 
| Last Update Date | 2017-02-20 |