| NPI | 1356334387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD00031678) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD00031678) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-04-05 |