| 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 |