| NPI | 1760942494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: WA MD61543077) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD61543077) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-08-16 |