| NPI | 1528009990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA G41004) |
| Additional Taxonomies | 207YS0012X (Licence: WA MD00022010) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: WA MD00022010) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WA MD00022010) | |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: WA MD00022010) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD00022010) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2013-05-03 |