| NPI | 1336125798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60101869) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WA MD60101869) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2021-06-16 |