NPI | 1366097693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 023778) |
Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 23778) |
363A00000X Physician Assistant (Licence: NY 023778) | |
Enumeration Date | 2019-08-05 |
Last Update Date | 2023-06-30 |