| NPI | 1366096950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 320117) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA 320117) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2021-08-04 |