NPI | 1114331972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA OP60937550) |
Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MI 5101021097) |
Enumeration Date | 2014-06-19 |
Last Update Date | 2019-08-16 |