| NPI | 1659632867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WA MD60783477) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA 60475596) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2022-10-06 |