| NPI | 1558359539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: 1061910) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX PA09879) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2022-01-27 |