| NPI | 1659012508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2827) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AL NA) |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical (Licence: NE 2827) | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2023-02-14 |