| NPI | 1326005968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD0010955) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD00010955) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2011-09-28 |