| NPI | 1841261492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61139453) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA AP30007073) |
| 207Y00000X Otolaryngology (Licence: MT MED-PHYS-LIC-18285) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-11-11 |