| NPI | 1497898969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: WA MD00029686) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: WA MD00029686) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2017-11-08 |