| NPI | 1316505159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61654613) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WA MD61654613) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2026-05-22 |