| NPI | 1780728204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA 115735) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA MD60140057) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2011-10-07 |