| NPI | 1518429315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61687221) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: WA MD61687221) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2026-02-24 |