| NPI | 1427646116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 60737) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA 60737) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2024-11-17 |