| NPI | 1780673392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA 60135833) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA 60135833) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2021-10-19 |