| NPI | 1316973811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD00047524) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A65142) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2021-04-05 |