| NPI | 1396388724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3964) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 3964) |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-10-17 |