| NPI | 1457305401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WA MD00047270) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AK 5371) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2011-01-24 |