| NPI | 1124057682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD00024865) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA MD00024865) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WA MD00024865) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-03-07 |