| NPI | 1104203793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61047604) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WA MD61047604) |
| Enumeration Date | 2015-05-03 |
| Last Update Date | 2023-08-17 |