| NPI | 1508826744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD00033729) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OR MD20967) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-08-02 |