| NPI | 1679867378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60642199) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: UT 8405867-1205) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2021-11-11 |