| NPI | 1982652517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD00012049) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD00012049) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2025-09-11 |