| NPI | 1043294655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD00045831) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00045831) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-10-23 |