| NPI | 1740592849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA 60671191) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: GA 073020) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2022-10-07 |