| NPI | 1609834258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: WA MD00022586) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD00022586) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-10-19 |