| NPI | 1376649624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0012X (Licence: WA MD00035815) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD00035815) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2016-12-21 |