| NPI | 1104907468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: WA OP00001440) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA OP00001440) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-02-12 |