| NPI | 1912064577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: WA MD60187241) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 47898-020) |
| 207Y00000X Otolaryngology (Licence: MA 242010) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: WA MD60187241) | |
| 208600000X Surgery (Licence: WA MD60187241) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60187241) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2012-03-15 |