| NPI | 1417243668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60681545) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA MD60681545) |
| 207Y00000X Otolaryngology (Licence: CA A140770) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2023-10-06 |